Retrospective Comparison of Endoscopic Versus Open Procedure for Mitral Valve Disease

Abstract

Objectives

We investigated whether the totally video-assisted thoracoscopic mitral valve surgery provides superior clinical outcomes and less inflammatory injury reaction compared with conventional sternotomy.

Methods

A total of 504 consecutive patients admitted for mitral valve surgery from May 2014 through May 2019 in a single center were retrospectively analyzed according to two distinct procedure approach: the totally video-assisted thoracoscopic approach (group A, n = 127) and standard median sternotomy (group B, n = 377). The primary end point was the durations of cardiopulmonary bypass, aortic cross-clamping, the ventilation time and intensive care unit of stay; the secondary endpoints included inflammation indexes like high sensitivity C-reactive protein, neutrophil-lymphocyte ratio and metabolic injury parameters cardiac Troponin and lactate.

Results

There was only one in-hospital death due to diffuse intravascular coagulation in group A, but similar complications such as repair failure, re-thoracotomy and stroke in both groups. The durations of cardiopulmonary bypass and aortic cross-clamping were significantly longer in group A. In contrast, ventilation time and intensive care unit of stay were shortened compared with these in group B. In addition, postoperative equivalent lactate clearance but lower high sensitivity C-reactive protein, neutrophil-lymphocyte ratio and cardiac Troponin level was in group A than those in group B within postoperative 24 hours(P < 0.05).

Conclusions

The analysis of present study indicated despite relatively longer cardiopulmonary bypass time, the totally thoracoscopic mitral valve procedure seemed to be favorable with regard to the extent of inflammatory reaction, cardiac injury and postoperative recovery compared with conventional median sternotomy.

Keywords:

• Cardiopulmonary bypass
• thoracoscopy
• mitral valve
• minimally invasive surgical procedures
• biomarkers

This article is referred to by:

Minimally Invasive versus Conventional Mitral Valve Surgery. A Clinical Equipoise or Not Really?

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Funded by National Natural Science and Technology Foundation of China (81800274) and Clinical study and translation grant of Sichuan Provincial People’s Hospital (2017LY07).